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Fibromyalgia (FM) and
Chronic Myofascial Pain (CMP)
For Doctors and 
Other Health Care Providers

with Devin Starlanyl

 

 

Resources

A Headache in the Pelvis: A new understanding and treatment for chronic pelvic pain syndromes, by David Wise PhD and Rodney Anderson MD. Clear instruction in treatment for pelvic floor pain, including instructions for internal pelvic floor TrP work.


EEG Stimulation: Neurotherapy and Fibromyalgia


Frequency Specific Microcurrent for Fibromyalgia and Myofascial Pain - January 2011


Updated  Information on Guaifenesin


Healing the Dysfunctional Gut: A Common Hidden Key Perpetuating Factor


The papers and effects of Janet G. Travell, MD, one of the founders of myofascial medicine, have been carefully and lovingly archived at the Gelman Library in George Washington University.  If you plan to visit, please contact them beforehand and read through the carefully compiled list of documents that are available so that the archivists can have specific boxes ready and available for you. 


A myofascial trigger point (TrP) is always found in a taut band, which is structurally related to contraction knots caused by a thousand-fold increase in the release of acetylcholine, an important neurotransmitter.  This action takes place in an area of the muscle where nerves end, which is called a motor endplate (Gerwin, 1999).  The cause of TrPs appears to involve serious disturbances of the nerve ending, as well as dysfunction of the contractile mechanism at multiple dysfunctional endplates (Hong, 1999).  

Some TrPs lie within the pain pattern and refer pain in that general area, and some refer pain to an area distant from the TrP.  Some do both.  Myofascial TrPs can cause muscle weakness and dysfunction, severe pain, nerve and blood/lymph vessel entrapment, TMJD, Carpal Tunnel Syndrome, Thoracic Outlet Syndrome, impotence, low back pain, pelvic pain, frozen shoulder, tennis elbow, headaches, piriformis syndrome, and many other conditions, as well as pain that may be mistaken for many other ailments.  Unless you are trained to recognize these pain patterns and the TrPs to which they belong (as well as the non-pain symptoms which can occur with TrPs, you will be mystified.  Common appropriate therapies for myofascial pain provide substantial abrupt reduction in pain intensity (Skootsky, Jaeger and Oye, 1989).  Physical and occupational therapists, as well as doctors, often recommend strengthening exercises without understanding that the TrP is inhibiting the muscle, and you cannot strengthen a muscle with a trigger point.  Improper physical therapy and lack of adequately trained medical care providers can be prime perpetuating factors.

Hands-on training is available.  Hands-on myofascial trigger point training for care providers is offered at www.myopainseminars.com.


The International Myopain Society

The International Myopain Society (IMS) is an organization dedicated to education about and exploration of musculoskeletal pain. If you treat patients/clients with musculoskeletal pain, IMS membership will repay your investment many times over. This multi-disciplinary organization offers educational opportunities and chances for Continuing Education Credits, including on-line training, regional meetings, workshops, and the International Myopain Congress. Here you will find developing research, often with a chance to meet and discuss that work with those who are involved. The interaction among many disciplines in the IMS nurtures creative solutions to many common problems. A subscription to The Journal of Musculoskeletal Pain is part of membership, and keeps you informed on the latest research in fibromyalgia, chronic myofascial pain and soft tissue conditions.

For more information, visit the IMS website at:www.myopain.org
To donate towards IMS-funded research in musculoskeletal pain, see: To Donate


NAMTPT

If you are a doctor or other care provider who deals with patients have fibromyalgia (FM), you may not be aware that research has shown peripheral pain generators such as myofascial trigger points and arthritis are the driving cause of the central nervous system sensitization of FM.

If you already know about chronic myofascial pain, you may not be aware of all the dysfunctions that can be caused by trigger points. They can be responsible for or contribute to migraines, irritable bowel syndrome, blurry vision, temporomandibular dysfunction, "chronic prostatitis", menstrual cramps, buckling hip or know, decreased tidal volume, and many other dysfunctions as well as pain. They are the great mimicker, causing symptoms that can be difficult to differentiate from other conditions. It can be mind-boggling to try to remember all of the trigger point referral patterns and symptoms involved with the hundreds of possible trigger points, as well as their perpetuating factors. Most chronic pain patients do have trigger points, and they are the most common source of musculoskeletal pain. Would you like some help?

Did you know that here are specialists trained in identifying and treating trigger points and dealing with at least some perpetuating factors? The National Association of Myofascial Trigger Point Therapists can help you locate a therapist near you. Working with such a therapist can relive you of considerable amont of work, and help your patients help themselves. If none is near you, you may want to help recruit a graduate of one of the training facilities mentioned on their website. If you are a bodyworker and interested in learning more about trigger points, the NAMTPT website has training opportunities and a symptom seeker that can help you.

Visit the NAMTPT website at www.myofascialtherapy.org


For information on "Myofascial Pain and Dysfunction: The Trigger Point Manuals", click here.


Clinical Mastery in the Treatment of Myofascial Pain, by Lucy Whyte Ferguson and Robert Gerwin.  In my opinion, this book should be read and reread by anyone who practices any form of myofascial pain medicine.  If you want to know which order to treat TrP-laden muscles and how to release difficult areas and so much more, it’s here, waiting for you.


Have you ever wanted to do something more for your fibromyalgia and chronic myofascial pain patients/clients, but time would not allow it? What about a national informational support newsletter that comes right to their door? The National Fibromyalgia Partnership provides this and more in the way of resources for your patients/clients. There are informational handouts (English and Spanish), guidelines for setting up a support group, guides to government resources, and many other topics. For more information and resources advise them to visit www.fmpartnership.org


The Winner’s Guide to Pain Relief, by myofascial pain specialist Hal Blatman, MD, and Brad Ekvall, BFA, is ready to teach you how to improve your quality of life.  For information on a complete guide for patient myofascial self-therapy written by a physician specializing in myofascial therapy, click here.

For extra information on myofascial TrPs by Tasso Spanos, the founder of the original Academy for Myofascial Trigger Point Therapy, including access to a diagnostic chart to help you figure out which TrPs are contributing to interscapular pain, and an exercise DVD designed specifically for people with myofascial TrPs, click here.  Patients with chronic myofascial pain or multiple TrPs and fibromyalgia are advised to begin the exercise program slowly, doing only a small amount of the exercises the first day, with no repetitions.  If this is tolerated with minimal post-exercise soreness, more of the exercises can be added the next day.


For information on myofascial trigger point examinations and related course programmes in Ireland, visit the National Training Center in Dublin at www.ntc.ie   


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